IP Care Management Consultant I

Genesis Healthcare System•Coshocton, OH

About The Position

The Care Management Consultant assists patients in navigating the healthcare system by acting as a patient advocate and navigator. The role creates longitudinal, personalized care plans, collaborates with and coordinates providers across the continuum of care, and increasingly uses data analytics to manage population health. The position supports high-risk patients and works to ensure continuity of care, appropriate resource use, improved outcomes, and reduced readmissions. The role works with patients, families, physicians, interdisciplinary teams, primary care practices, community organizations, and other healthcare partners. It coordinates care across inpatient, outpatient, and community settings; supports utilization management and outcomes reporting; and helps evaluate care programs and identify opportunities to improve quality and resource use. Genesis employees are expected to live the organization’s Mission, Vision, and Values, provide compassionate and respectful patient-centered care, protect privacy, communicate effectively, and contribute to patient and employee safety. This role is in the GCMC Case Management department, on the day shift, with 40 scheduled hours per week.

Requirements

Current Ohio RN licensure.
Either a BSN and 3 years of clinical RN experience, or an ADN and 7 years of clinical RN experience.
Three years of clinical experience and at least 2 years of case management, utilization review, navigator, coordinator, or leadership experience; alternatively, Case Management Certification or an approved alternate certification applicable to the assigned service area.
Demonstrated leadership skills, including department team leadership, mentoring, motivating, positively influencing patients and others, and department project management.
Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
Understanding of pre-acute and post-acute care settings and post-acute community resources.
Excellent oral and written communication and customer service skills.
Ability to work independently, set priorities, and coordinate care plans efficiently.
Ability to work effectively in a team environment.
Highly organized and detail-oriented, with the ability to perform multiple tasks.
Confidence communicating and conducting outreach to community healthcare organizations and personnel.
Sound judgment, decision-making, and problem-solving ability.
Ability to hear, speak, see, and coordinate motor skills.
Ability to climb, lift 25 pounds, stoop, and bend.
Ability to collect data, interpret findings, set priorities, and carry out an established plan.
Ability to read, write, and use manual and computerized documentation systems, and to read a significant amount of information in a relatively short period.

Responsibilities

Assess patient and family needs by coordinating input from health professionals and develop documented plans to ensure continuity of care for high-risk patients.
Coordinate continuity of care with patients and families following hospital admissions, discharges, and emergency room visits.
Delegate care tasks according to the situation, remain accountable for patient outcomes, and support and hold assistive personnel accountable for completing delegated tasks.
Lead and coordinate interdisciplinary treatment team activities with physicians, hospitalists, primary care providers, advanced practice providers, and specialists for high-risk clinical, benefit, and network decisions.
Identify appropriate providers, facilities, and external healthcare organizations across the continuum of care, and maintain positive working relationships with patients, families, providers, and the interdisciplinary team.
Coordinate and manage a defined health population across multiple care settings and for multiple physicians, healthcare providers, or health plan counterparts.
Coordinate inpatient, outpatient, and community care to ensure appropriate use of clinical and community resources.
Work collaboratively with primary care practices to provide individualized assistance in improving and maintaining quality patient care.
Guide the development of healthcare partnerships to achieve positive health effects.
Ensure transitions of care are completed for assigned patients and that patients have resources to improve outcomes and prevent readmissions.
Explain system-wide care management to patients, tell them how to get in touch with the consultant, and consider their goals and preferences when developing care plans.
Manage high-risk patients, including those with multiple comorbidities or elevated risk of hospital readmission, using a patient registry when appropriate.
Participate in data collection, health outcomes reporting, clinical audits, and program evaluation as needed.
Analyze data—including predictive analyses, risk stratification, cost-benefit and financial analyses, clinical outcomes, utilization, and practice patterns—to identify under- or over-utilization, improve resource consumption, reduce potential costs, and enhance care quality in line with organizational goals.
Participate in ongoing review and readmission root-cause analysis, and develop action plans for the assigned patient population.
Use effective behavioral and educational strategies, including motivational interviewing, teach-back, and self-management support.
Demonstrate patient-centered behavior, protect confidential information, respond to requests in a timely manner, and contribute to a safe, clean, quiet, and healing environment.
Follow patient-handling, materials-handling, infection-prevention, and slips, trips, and falls safety practices.